A Beach to Remember

Our work in healthcare doesn't stop when we're sad or traumatised, our patients deserve the highest quality of our care no matter the circumstances. With our workload it's impossible to remember all of our patients, there's simply too many. Hopefully the ones you do remember are due to lovely glorious reasons, but often as not we don't get so lucky. This is one of those.

On this particular day I was covering the emergency list, and a case came in of a young Zed who needed a manual evacuation due to constipation. We had been told this youngling had a four day history of severe pain with a massively swollen abdomen. The surgeons were worried about a perforation, where all that backed up poo could have burst the intestine open and leaked into the abdomen. We were also informed that the youngling was neurodivergent and was unaware of what they were having done.

That didn't sit well with me. It is, of course, the parent's right to determine what their child knows about their procedures, but I personally feel that preparedness is key to successfully engaging with the anaesthetic process and avoiding future trauma. At this stage I don't know if there are other circumstances that lead to this child being unaware, I don't know if there is global developmental delay or a particular sensitivity to hospitals, I know nothing more than what had been previously stated.

Young Zed comes into the anaesthetic room having been told they were going to the beach. They have their swimming costume, complete with a shovel and pail. Parent tells them to get up on the bed and the nice people in pyjamas will take them through to the beach which lay just beyond the doors.

We start with our gas induction, and it goes terribly wrong. It's a plastic smell and a hand cupping right under their chin. They don't like it. Zed is confused and scared, we're trying to ask them what they like to do at the beach, are they going to build sand castles? All they want is to be let go and get out of here. Parent is trying to be soothing, in the end we ask they get on the bed and cuddle their young one. Zed gets more agitated. Kicking, flailing, screaming, begging us to let them go. Pleading that we don't do this. To please stop.

Parent is crying, I have tears building but refusing to fall, anaesthetist is looking uncomfortable, ward nurse gets so overwhelmed they leave the room. We've started now, once you start you can't really stop, it's not safe. We have to hold Zed down, open cupped hands trying to gently stop them from kicking and hitting. The screams get louder, desperate sobbing as they turn to parent and beg. They swear they'll be good, they're sorry for whatever they did wrong. To just please stop.

It almost over, words are being mumbled, movement without purpose, head lulls from side to side. Eyes flutter before finally drifting shut. The cupped hand is replaced by a mask, we ask parent to leave not able to bare telling our usual comforts of "They did great, we'll take good care of them, go get yourself a cuppa tea." No. This time it's quiet. "They're asleep, it's time to go now."

Ward nurse re-emerges to guide them back to the ward. Parent is sobbing as they climb off the bed. The doors close with a loud 'schnick'. Oxygen probe goes on, and the tears fall. The anaesthetist gives me a minute to compose myself, gently bagging the child. The only sound in the room is the beeping of the monitor and the sounds of my sobs.

Time passes, a minute or two or five, I don't know. I am back under control. I look at the anaesthetist, who looks back and says "That was pretty terrible." I nod, and we get ready to cannulate, moving on with the case.



That was one of the worst inductions of my career to date.

The department changed things after that. More anaesthetists took the time to meet the patients and parents first, more ODPs did the same, we offered slightly longer time slots and more involved play therapy to help ease the fear. This youngling made a difference to so many others having inductions. Our perceptions of how we engage with neurodiverse children were altered permanently. I know that means nothing to the individual who will be traumatised for life, probably never to trust beaches or hospitals ever again. I am simply glad that the truly horrific experience held meaning. It changed me as a practitioner and changed the culture within that department.



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